Intercostal catheters



J1me 1965 R. D. ALLEY ETAL 3,

INTERCOSTAL CATHETERS Filed Feb. 8, 1962 United States Patent 3,196,290INTERCOSTAL CATHETERS Ralph D. Alley, Loudonviiie, and David S.Sheridan, Argyle, N.Y., assignors to Brunswick Corporation, acorporation of Delaware Filed Feb. 8, 1952, Ser. No. 171,906 6 Claims.(Cl. 128-449;)

The present invention relates to catheters and more particularly to anXray catheter which is particularly useful as an intcrcostal catheter.

United States Patent 2,857,915 describes an X-ray catheter which isconstructed as an extruded seamless nonfibrous tube of flexibletransparent waterproof plastic material having a continuous strip ofX-ray opaque material extending longitudinally along the entire lengththereof. The strip of opaque material appears as a line where X-raytechniques are utilized to determine the exact position of the catheterin the body. In many surgical and clinical procedures, it is not onlydesirable but sometimes necessary that the exact location of a catheteras it passes through the body tissues be known. Since such a catheter asdisclosed in United States Patent 2,857,915 is transparout to light, thepresence of matter may be observed through the catheter as it isconducted through the portion thereof outside the body. Thus, a catheterconstructed in accordance with the aforementioned patent can be locatedby X-ray techniques inside the tissues of the body and fluids flowingthrough the portion of the catheter outside the body may be observedthrough its transparent plastic structure The distal end portion of sucha catheter normally has a number of inlet openings for receiving fluidsfrom a desired portion of the body. Often, it is desirable not only tolocate the path of the catheter as it passes through the'body tissuesbut to positively identify the location of these inlet holes or at leastthe hole furthest from the distal end to insure that it has not movedtoo far from a desired position. An example of such a situation is theuse of an intercostal catheter following chest surgery. In thepostoperative period during which the distal end of a catheter remainswithin the chest cavity it is necessary that the position of the lasthole from the end of the catheter distal portion be known inrelationship to the chest layers. If there is no mark to indicate theposition or" such a hole that can be recognized by X-ray techniques, theposition of that hole cannot be ascertained with certainty, particularlyin a surgical procedure where a portion of the catheter distal portionmay be cut off prior to insertion in the body. The present inventionprovides a means for accurately locating the position of such a lastinlet opening by X-ray techniques.

lntercostal catheters and catheters utilized in similar surgicalprocedures are inserted through the original incision with the proximalend portion entering the incision first; a second incision is made;forceps are inserted through the second incision to grasp the proximalend of the catheter; and the catheter is thereby pulled into the bodyuntil the distal end portion is properly positioned with the tubeleading out through the second incision. Then the proximal end isconnected to an appropriate tubular connector. At the present time, theproximal end of conventional catheters in general usage have a proximalend opening lying in a plane which is approximately at right angles to acenter line of the tube. When the gripping or jaw portions of forceps donot exceed the diameter of the proximal end opening, it is distortedwhen externally gripped by both jaws of the forceps so that oppositeportions of the end are forced out from between the jaws as pressure isapplied by the forceps to form a ciosed end having two protruding pointswhich may act as dull barbs as the proximal end portion is pulledthrough the body tissue to the second incision. These protruding barbsmay rip or tear tissue during this process. If the forceps are appliedto the proximal end of a conventional catheter now in general usage sothat one jaw is placed internally and the other is placed externally togrip the catheter, the proximal end is not distorted, but that portionof the circumference of the proximal end which is not between thegripping jaws of the forceps will make an even larger barb to catch andtear the body tissue as the forceps are used to draw the proximal end toand through the second incision. A further accomplishment of the presentinvention is to eliminate such ripping and tearing by a unique proxi malend portion for a catheter.

Therefore, it is an object of the present invention to provide acatheter having a proximal end portion which may be gripped by forcepsto withdraw the proximal end through body tissue without ripping ortearing the body tissue.

A further object of the present invention is to provide an X-raytransparent catheter having an opaque X-ray line running longitudinallytherethrough with that opaque line being interrupted by the inletopening furthest from its distal end.

Another object of the present invention is to provide a new and improvedcatheter.

A primary object of the present invention is to provide an intercostalcatheter composed of a light and infrared transparent material having anX-ray opaque line embedded longitudinally therein with the opaque linebeing interrupted by the inlet opening furthest from its distal end anda proximal portion end havins an outlet opening lying in a plane whichmakes less than a 45 angle with a center line of the proximal endportion.

Yet another object of the present invention is to provide a catheterhaving a flared proximal end portion which is capable of being easilyremoved from a tubular connector.

Further objects and advantages will become apparent from the followingdetailed description taken in connection with the accompanying drawings.

In the drawings:

FIGURE 1 is an elevational view of an embodiment of the presentinvention;

FIGURE 2 is a side elevational view of the embodiment of the inventiontaken along the lines 2-2 of FIGURE 1 when the proximal end portion isgrasped by forceps; and

FIGURE 3 is a pictorial view of the proximal end portion of theembodiment of the invention shown in FIG- URE 1 being removed from atubular connector.

While this invention is susceptible of embodiment in many differentforms, there is shown in the drawings and will herein be described indetail, an embodiment of the invention with the understanding that thispresent disclosure is to be considered as an exemplification of theprinciples of the invention and is not intended to limit the inventionto the embodiment illustrated. The scope of the invention will bepointed out in the appended claims.

As aforementioned it has previously been the practice to grasp theproximal end of a catheter with either both jaws of a forceps externalor with one jaw internal so that as the forceps are withdrawn to andthrough the second incision, a portion of the proximal end of aconventional catheter will frequently rip or tear the tissue throughwhich the forceps are being withdrawn because the right angle edgesproduced by the proximal end of a conventional catheter produce barbswhich easily dig into the tissue through which the forceps are beingwithdrawn. The construction of a catheter shown in the drawingseliminnates this tearing and ripping effect as the forceps are withdrawnto pull the proximal end out through the second incision. To utilizethis catheter construction, a pair of forceps are inserted in the secondincision until they are in position to grasp the tip of the proximal endwhich with conventional catheters. rip the patients tissue with thebarbs formedvby the which the end 21 lies and the center .line'necessary to work one jaw into the circular hole of the conventionalcatheter. Thus the present invention eliminates both the problem ofopening the forceps wide enough to grasp the catheter with both jawsexternal to the catheter or maneuvering to shove one jaw into the endof' the tube. The forceps are then withdrawn through the tissue whichthey have penetrated from the second incision drawing the slantedproximal end smoothly through the tissue. As the forceps pass throughthe tissues, the tissues are not contacted by any blunt barb but areparted smoothly for the passage of the maximum diameter of the catheter.Thus the present invention does not rip or tear as it passes through thetissue but smoothly parts the-tissue to allow the maximum diameter ofthe catheter to easily slide therethrough.

The proximal end portion is withdrawn through the second incision untilthe distal end is believed to be in its correct position within thebody. X-ray techniques can be utilized with the catheter constructionshown in the draw ingsto precisely locate not only the distal endportion in general but theposition of the holes in the distal end. 'Bythe use of earlier X-ray catheters, it had been possible to locate thepath of the catheter, but it had been impossible todefinitely locate theposition of the distal end holes in relation to the body structure. Bythe use of the present invention the exact position of the distal endand its holes may be located so that the surgeons now may know that.

the holes in the distal end are draining the correct area of the bodyand that they are not draining an incorrect area. Thus as will beseenfrom the following detailed description, it is now possible for asurgeon to eliminate'not only the tip 23 is pulled toward the tubeportion 10 of the catheter. I

When a catheter of the type illustrated is to be utilized in a chestsurgical procedure, the distal end portion 11 may remain as illustratedwith the, six inlet openings 1318 and the open end 19 availableto'receive fluids from the section of the body wherein they are placed,or a length of the distal portion 11 may be cut off so'that only a fewinlet openings remain. in the distal portion 11. Regardless of thenumber of inlet openings remaining, the exact length of the entirecatheter or the length of the distal portion 11, the last inlet opening18 may be located by X-ray techniques because the inlet opening 18 willshow up on X-ray plates or fluoroscopes as a .break in the X-ray opaqueline 20. Although the embodiment illustrated shows the inlet opening 18furthest from the distal end interrupting the line, it will beunderstood that other struc ture within the scope of the presentinvention may utilize more than one inlet opening to interrupt the,X-ray opaque line and that in other applications of such a catheter thatit may be desirable to have an inlet opening other than the one but bothof the problems thatare presently associated I No longer must he tear orproximal end of the catheter and no longer must he be uncertain aboutthe exact position of the distal end of the catheter after it isinserted.

Referring initiallylto FIGURE 1, a catheter is composed of a tubeportion 10, a distal end portion 11, and a flared proximal end portion12. The distal end portion has a series of inlet openings 13-18 and anopen distal end 19. The catheter is constructed of a seamless flexibleplastic material which is transparent to both light and X- rays.Embedded in the plastic material is an X-ray opaque line runninglongitudinally along thecatheter. The opaque line 20 is interrupted bythe inlet opening 18 which is the most remote opening from the end 19 ofthe distal portion 11.

As may be seen in FIGURE 2 the plane of a proximal opening 21 is at anangle of less than from the center,

line 22 of the proximal end portion 12. Although this lar shape :of theproximalportion 12. In the embodiment illustrated in FIGURE 2; the anglebetween the, plane'in 22 is approximately 30.

Since the proximal end is internally flared, it'may fit' over connectingtubes of varying external diameter; lWhen the proximal end has beenattached to a connector as ilillustrated in FIGURE 3. Thus, the interiorwalls of the proximal portion 12 will loosen a grip on a connector as*ceps 24. As illustrated-in FIGURE 2, the forceps may grasp the slantedend section 23 of the flared opening 21 so as not to distort thecircular shape of the proximal end portion 12 or'its opening 21.. LAsthe forceps are withdrawn through the second incision with the slantedproximal end smoothly parting the tissue to allowfor the passage of themaximumdiameter, the distal end portion 11 is drawn through the primaryincision and into the body tissue until it arrives at the desiredposition. The position of the path of the entire catheter and theposition of the inlet holes may now be determined by either X-ray orfluoroscope techniques prior to completing the surgical procedure or atany time after its completion to insure that the inlet openings and'thetube end has not slipped or moved to an undesirable position.

We claim:

1. A catheter. having a distal end and a proximal end comprising a tubeof flexible material transparent to X-rays, a longitudinal line of X'rayopaque material embeddedin said material, andan inlet openinginterrupting said line of X-ray opaque material near thedistal end.

2. A surgical catheter having a distal end and a proximal end adapted tobe withdrawn through a secondary incision during a surgical proceduresubsequent to its insertion into the 'body through a primary incisioncomprising a tube of flexible material and'a proximal end portion havingan end opening lying substantially in a plane which forms less'than a 45angle with a centerline of said proximal end portion whereby a slantedend section is formed which is adapted .to be graspedby forceps forWithdrawing the proximal end portion through an incision, said slantedend section smoothly parting tissue surrounding the incision to allowfor the passage of the (i0:

proximal end portion without ripping said tissue during said withdrawal.

3. A catheter having a distal end and a proximal end comprising a tubeof flexible material transparent to X-rays, a longitudinal line of X-rayopaque material embedded in said material, an inlet opening interruptingsaid line of X-ray opaque material near the distal end, and a proximalend portion having an end opening lying substantially in a plane whichforms less than a 45 angle with a centerline of said proximalendportion.

4. A catheter having a distal end and aproxirnal end.

comprising a seamless tube of flexible plastic material transparent tolight and X-r'ays, a longitudinal line of X-ray opaque material embeddedin said plastic material,

a and a number of inlet openings depressed near the distal end With onlythe inlet opening furthest from the distal end interrupting said line ofX-ray opaque material.

5. A surgical catheter having a distal end and a proximal end adapted tobe Withdrawn through a secondary incision during a surgical proceduresubsequent to its insertion into the body through a primary incisioncomprising a seamless tube of flexible plastic material and a proximalend portion of increased internal and external diameter having an endopening lying substantially in a plane which forms less than a 45 anglewith a centerline of said proximal end portion.

6. A non-absorptive catheter having a distal end and a proximal end,comprising an extruded, seamless, nonfibrous tube of flexible,waterproof plastic material transparent to light and X-rays; alongitudinal line of X-ray opaque material embedded in said plasticmaterial; a number of inlet openings depressed near the distal end Withonly the inlet opening furthest from the distal end interrupting saidline of X-ray opaque material; and a proximal end portion or" increasedinternal and external diameter having a slanted end opening adapted tobe grasped by forceps Without distorting its normal crosssectionalshape.

References Cited by the Examiner UNITED STATES PATENTS AmericanCystoscope Makers, Inc., page 24, copyright 1960.

RICHARD A. GAUDET, Primary Examiner.

RICHARD J. HOFFMAN, Examiner.

1. A CATHETER HAVING A DISTAL END AND A PROXIMAL END COMPRISING A TUBEOF FLEXIBLE MATERIAL TRANSPARENT TO X-RAYS, A LONGITUDINAL LINE OF X-RAYOPAQUE MATERIAL EMBEDDED IN SAID MATERIAL, AND AN INLET OPENINGINTERRUPTING SAID LINE OF X-RAY OPAQUE MATERIAL NEAR THE DISTAL END. 2.A SURGICAL CATHETER HAVING A DISTAL END AND A PROXIMAL END ADAPTED TO BEWITHDRAWN THROUGH A SECONDARY INCISION DURING A SURGICAL PROCEDURESUBSEQUENT TO ITS INSERTION INTO THE BODY THROUGH A PRIMARY INCISIONCOMPRISING A TUBE OF FLEXIBLE MATERIAL AND A PROXIMAL END PORTION HAVINGAN END OPENING LYING SUBSTANTIALLY IN A PLANE WHICH FORMS LESS THAN 45*ANGLE WITH A CENTERLINE OF SAID PROXIMAL END PORTION WHEREBY A SLANTEDEND SECTION IS FORMED WHICH IS ADAPTED TO BE GRASPED BY FORCEPS FORWITHDRAWING THE PROXIMAL END PORTION THROUGH AN INCISION, SAID SLANTEDEND SECTION SMOOTHLY PARTING TISSUE SURROUNDING THE INCISION TO ALLOWFOR THE PASSAGE OF THE PROXIMAL END PORTION WITHOUT RIPPING SAID TISSUEDURING SAID WITHDRAWAL.